New developments in respiratory medicine: discussions at the American Thoracic Society 2013 meeting

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The Division of Lung Diseases of the National Heart, Lung, and Blood Institute funds a significant amount of research on the causes, diagnosis, prevention and treatment of lung diseases and sleep disorders in the US. Advances in these areas were discussed at the recent American Thoracic Society meeting (ATS 2013), where BMC Medicine joined over 13,000 delegates to hear the latest developments in this field.

The meeting addressed several controversial topics in COPD, which included an interesting presentation by BMC Medicine’s Editorial Board Member Wisia Wedzicha on the effective use of macrolides to prevent exacerbations, which can cause severe illness, disability and death if not treated in time. As highlighted by Bartolome Celli, it is therefore important to treat COPD early to reduce disease progression. As part of COPD treatment many patients have to undergo pulmonary rehabilitation to help slow the progression of the condition and reduce the symptoms. This is a topic of much debate, and has been addressed in the ERS/ATS statement on COPD management. Many speakers at ATS 2013 emphasized that guidelines are useful and multi-disciplinary care should be nurse-led and patient centered. Other recent advances in COPD that were highlighted at the meeting focused on common and rare genetic variants, epigenetics and genomics for the prediction and progression of the disease.

Like COPD, asthma is a very common lung disease, affecting 235 million people globally, and it is classified by the World Health Organization (WHO) as the most common chronic disease in children. The severe asthma research program (SARP) aims to improve the understanding of severe asthma in order to develop better treatments. At ATS 2013, Scott Weiss described how disease progression can be predicted in mild to moderate asthmatics using an integrative OMICs approach. These studies will be useful for better management and treatment of the disease. In order to develop new therapies for asthma, it is important to understand the mechanisms of airway remodeling. In a minireview article published in BMC Medicine, Christopher Brightling and colleagues explore the different cell types that may contribute to asthma pathophysiology, and discuss new therapies such as bronchial thermoplasty that target smooth muscle cells.

The management of pediatric asthma is challenging as it involves preventing exacerbations and the NHLBI guidelines for diagnosis and management of asthma are currently being updated. Stanley Szefler discussed this revision for pediatric asthma at ATS 2013 and emphasized the need to include risk and severity profiles and biomarkers, as well as improving the communication amongst clinicians, parents and providers.

While the research into asthma and COPD is ongoing, other lung diseases such as idiopathic pulmonary fibrosis and connective tissue disorders (CTD)-interstitial lung diseases have been given more prominence based on emerging evidence. There was much debate at ATS 2013 on pulmonary fibrosis, focusing on whether mortality or quality of life is a better optimal end point for phase III studies and whether the epithelial mesenchymal interface is the most promising target for novel therapies for this lung disease. In another controversial session on CTD-interstitial lung diseases, Athol Wells was in favor of immunosuppression treatment for patients with connective tissue disorders (CTD) and usual interstitial pneumonia (UIP). However, the counter argument was in support of the use of different drugs for the diverse patterns of UIP.

Overall the ATS 2013 meeting highlighted that genomic and integrative strategies are essential in understanding obstructive airway diseases, and continued progress using these methods will allow the application of more personalized approaches in treating lung diseases in the 21st century.